Biomedical subjects
Publications and source records attributed to H J Lewi.
Symptomatic presentation due to lymphocytic infiltration of the prostate is rare. Six patients are described in whom lymphocytic infiltration of the prostate was secondary to non-Hodgkin's lymphoma, chronic lymphatic leukaemic, and myeloid leukaemia. The prostatic infiltration was sufficiently extensive to result in outflow tract obstruction.
Fournier's classical description of infective genital gangrene has been frequently amplified. We present seven patients in whom the exact site of gangrene was related to the origin of the infection, either from the urethra or from the anorectum. A sixth case of diabetes presenting as Fournier's gangrene is described. The need for urological assessment in this condition is discussed.
Following surgery for the removal of intrarenal calculi 30% of patients will develop severe wound complications. This study assesses the role of a short course of netilmicin given over the operative period, in 20 consecutive patients. Preoperative studies demonstrated that whilst 20% of patients had bacterial growth in the urine, culture of the removed calculus demonstrated that 50% of the stones exhibited a significant bacterial growth. Of the 20 patients, only one developed a wound complication. Following the preoperative dose, satisfactory netilmicin levels were obtained and no patient had levels greater than 1 microgram ml-1 by 7 h. Despite some degree of renal impairment, serum urea and creatinine values were unaffected.
Peroperative and postoperative blood loss was studied in 20 patients. Both peroperative and postoperative blood loss was found to correlate together (p less than 0.05) and with the weight of resected tissue (p less than 0.05). The characteristics of the postoperative blood loss demonstrated a strong negative correlation with time, and calculation of the t50 showed that a 50% reduction in postoperative blood loss occurred within 16 h.
Prostatic involvement by non-Hodgkin lymphoma is rare. Infiltration of the gland by the uncommon plasmocytoid cells sufficient to cause clinical signs and symptoms of prostatic obstruction is described.
The effects of both an H1 receptor antagonist and an H2 receptor antagonist on changes in monovalent ion flux induced by topical sodium taurocholate were studied in antrectomised dogs fashioned with a denervated fundic pouch. The magnitude of taurocholate-induced ion flux was unaffected by topical administration of H1 or H2 receptor antagonists Parenteral administration of H1 or H2 receptor antagonist given singly or in combination produced an increase in net luminal Na+ gain before taurocholate administration but failed to reduce the magnitude of taurocholate-induced ion flux. It is concluded that histamine receptors are unlikely to have a role in the induction of mucosal injury by bile salts.
Second laparotomy was undertaken in 63 patients with suspected local recurrence following 'curative' resection for colorectal cancer. Nine patients proved to have benign disease and 4 a new cancer. Local tumour recurrence was confirmed in 50 patients. Of these, 19 underwent further resection of the tumour, 19 had palliative colostomy or bypass, and laparotomy only was performed in 12. Five of 15 patients undergoing secondary 'curative' resection survived 1 year and 3 survived 18 months. In contrast only 6 of the remaining 35 patients survived 1 year and none survived 18 months. Second laparotomy may be of benefit in a small number of patients with local recurrence following apparently curative resection for colorectal cancer.
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Delayed perforation, a complication of laser photocoagulation, could be reduced by accelerating healing and inhibiting gastric secretion. With the use of the Nd:YAG laser, a beam was passed through a single glass fiber (400 micrometer) with 10 degrees divergence at a constant power of 80 W for 1 sec at a 1-cm distance from the gastric mucosa. Rats were then randomly allocated to receive cimetidine (50 mg/kg), 15(S)15-methyl prostaglandin E2 (50 micrograms/kg), or saline intraperitoneally twice daily for 4 or 7 days. The surface area of ulceration at 4 days for the control rats and the cimetidine- and prostaglandin-treated rats was 29, 34, and 28 mm2, respectively, and was much larger than the initial lesion of 15 mm2. Histologically, all lesions showed the typical appearances of peptic ulceration with perforation in half the prostaglandin-treated rats. By 7 days, the surface area in the cimetidine-treated rats appeared to decrease, but the light microscopic changes were similar to the saline- and prostaglandin-treated rats. Neither cimetidine nor prostaglandin enhanced healing in this study.
These results indicate that computer assisted tomography of the brain, even when contrast medium enhanced, does not contribute to the detection of occult intracerebral metastases in patients with primary carcinoma of the breast and of malignant melanoma, even if the disease is locally advanced. The number of patients with malignant melanoma is still small, and this part of the study is continuing. However, we have discontinued the use of computer assisted tomography as a staging investigation for patients with carcinoma of the breast. Although the yield of positive scans in those 31 patients with metastatic, or locally recurrent, disease, but no neurologic symptoms, is subsequently found to be 13 per cent at follow-up study, this would not appear to be a profitable investigation in the absence of effective therapy. In our series of patients with neurologic symptoms, abnormal and positive scans were obtained in five of 18 patients. However, even in such patients, a negative computer assisted tomography did not exclude intracerebral metastatic disease. There is no place for routine computer assisted tomography as a staging investigation for patients with early carcinoma of the breast or with malignant melanoma. Its use should be restricted to those patients who have symptoms of cerebral disease.
Arteriovenous malforamtions of the intestine are recognized as an uncommon cause of chronic gastrointestinal bleeding. In previous reports, the role of selective mesenteric angiography in the localization of the lesion has been emphasized; with confirmation by in vitro injection of radioopaque dye into the resected specimen. The histologic appearances of arteriovenous malformations are well recognized, although terminology is still confused. In this report, two distinct entities of small vessel malformation are described and the terms submucosal endothelial angiodysplasia and submucosal fibromuscular angiodysplasia are offered.
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